Mesothelioma – Wikipedia

Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium).[1] The most common area affected is the lining of the lungs and chest wall.[2][3] Less commonly the lining of the abdomen and rarely the sac surrounding the heart,[4] or the sac surrounding the testis may be affected.[2][5] Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss.[2] These symptoms typically come on slowly.[6]

Greater than 80% of mesothelioma cases are caused by exposure to asbestos. The greater the exposure the greater the risk.[3] As of 2013 about 125 million people have been exposed to asbestos at work.[7] High rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos. Often it is around 40 years between exposure and the cancer starting.[3] Washing the clothing of someone who worked with asbestos also increases the risk.[7] Other risk factors include genetics and infection with the simian virus 40.[3] The diagnosis may be suspected based on chest X-ray and CT scan findings, and is confirmed by either examining fluid produced by the cancer or by a tissue biopsy of the cancer.[6]

Prevention centers around reducing exposure to asbestos.[8] Treatment often includes surgery, radiation therapy, and chemotherapy. A procedure known as pleurodesis, which involves using substances such as talc to scar together the pleura, may be used to prevent more fluid from building up around the lungs.[9] Chemotherapy often includes the medications cisplatin and pemetrexed.[6] The percentage of people that survive five years following diagnosis is on average 8% in the United States.[10]

In 2013 about 50,000 people had mesothelioma and 34,000 died from the disease.[11][12] Rates of mesothelioma vary in different areas of the world. Rates are higher in Australia, the United Kingdom, and lower in Japan.[3] It occurs in about 3,000 people per year in the United States.[13] It occurs more often in males than females. Rates of disease have increased since the 1950s. Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old. The disease was rare before the commercial use of asbestos.[3]

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.[14]

Mesothelioma that affects the pleura can cause these signs and symptoms:[14]

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread to other parts of the body.

The most common symptoms of peritoneal mesothelioma are abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other features may include weight loss, fever, night sweats, poor appetite, vomiting, constipation, and umbilical hernia.[15] If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.[citation needed] These symptoms may be caused by mesothelioma or by other, less serious conditions.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:[citation needed]

Pericardial mesothelioma is not well characterized, but observed cases have included cardiac symptoms, specifically constrictive pericarditis, heart failure, pulmonary embolism, and cardiac tamponade. They have also included nonspecific symptoms, including substernal chest pain, orthopnea (shortness of breath when lying flat), and cough. These symptoms are caused by the tumor encasing or infiltrating the heart.[4]

In severe cases of the disease, the following signs and symptoms may be present:[citation needed]

If a mesothelioma forms metastases, these most commonly involve the liver, adrenal gland, kidney, or other lung.[16]

Working with asbestos is the most common risk factor for mesothelioma.[17] In the United States, asbestos is considered the major cause of malignant mesothelioma[18] and has been considered “indisputably”[19] associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a signal or sentinel tumor.[20][21][22][23] A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc.[5][24] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[24] This has been confirmed in animal studies,[25][26] but studies in humans are inconclusive.[25][27][28] Pericardial mesothelioma may not be associated with asbestos exposure.[4]

Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among naval personnel (e.g., Navy, Marine Corps, and Coast Guard), shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and “permissible exposure limits” required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.[29] Likewise, the British Government’s Health and Safety Executive (HSE) states formally that any threshold for exposure to asbestos must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such “safe” threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.[30] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[19] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[19] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 13 months of exposure.[32][33] People who work with asbestos wear personal protective equipment to lower their risk of exposure.[citation needed]

Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 3040 years.[19] In a review of occupationally related mesothelioma cases, the median latency was 32 years.[34] Based upon the data from Peto et al., the risk of mesothelioma appears to increase to the third or fourth power from first exposure.[31]

The incidence of mesothelioma has been found to be higher in populations living near naturally occurring asbestos. People can be exposed to naturally occurring asbestos in areas where mining or road construction is occurring, or when the asbestos-containing rock is naturally weathered. Another common route of exposure is through asbestos-containing soil, which is used to whitewash, plaster, and roof houses in Greece.[7] In central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villagesTuzky, Karain, and Sarhdr. Initially, this was attributed to erionite. Environmental exposure to asbestos has caused mesothelioma in places other than Turkey, including Corsica, Greece, Cyprus, China, and California.[7][35][36] In the northern Greek mountain town of Metsovo, this exposure had resulted in mesothelioma incidence around 300 times more than expected in asbestos-free populations, and was associated with very frequent pleural calcification known as “Metsovo Lung”.[37][38]

The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.[citation needed]

Exposure to talc is also a risk factor for mesothelioma; exposure can affect those who live near talc mines, work in talc mines, or work in talc mills.[24]

Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.[39]

Commercial asbestos mining at Wittenoom, Western Australia, took place from 1937 to 1966. The first case of mesothelioma in the town occurred in 1960. The second case was in 1969, and new cases began to appear more frequently thereafter. The lag time between initial exposure to asbestos and the development of mesothelioma varied from 12 years 9 months up to 58 years.[40] A cohort study of miners employed at the mine reported that 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.[citation needed]

Occupational exposure to asbestos in the United States mainly occurs when people are maintaining buildings that already have asbestos. Approximately 1.3 million US workers are exposed to asbestos annually; in 2002, an estimated 44,000 miners were potentially exposed to asbestos.[24]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[5][41][42] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker’s clothes or coming into contact with asbestos-contaminated work clothing.[7][24] To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.[citation needed]

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK, use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos were banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.[citation needed]

In a recent research carried on white American population in 2012, it was found that people with a germline mutation in their BAP1 gene are at higher risk of developing mesothelioma and uveal melanoma.[43]

Erionite is a zeolite mineral with similar properties to asbestos and is known to cause mesothelioma.[5] Detailed epidemiological investigation has shown that erionite causes mesothelioma mostly in families with a genetic predisposition.[7][35][36] Erionite is found in deposits in the Western United States, where it is used in gravel for road surfacing, and in Turkey, where it is used to construct homes. In Turkey, the United States, and Mexico, erionite has been associated with mesothelioma and has thus been designated a “known human carcinogen” by the US National Toxicology Program.[36]

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.[citation needed]

Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than “feathery fibers” (chrysotile or white asbestos fibers).[19] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. “We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately,” said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System.[44]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.[citation needed]

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to a malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.[citation needed]

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.[citation needed]

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:[citation needed]

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

Several genes are commonly mutated in mesothelioma, and may be prognostic factors. These include epidermal growth factor receptor (EGFR) and C-Met, receptor tyrosine kinases which are overexpressed in many mesotheliomas. Some association has been found with EGFR and epithelioid histology but no clear association has been found between EGFR overexpression and overall survival. Expression of AXL receptor tyrosine kinase is a negative prognostic factor. Expression of PDGFRB is a positive prognostic factor.[46] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[47]

As an environmentally triggered malignancy, mesothelioma tumors have been found to be polyclonal in origin, by performing a X-inactivation based assay on epitheloid and biphasic tumors obtained from female patients.[48] These results suggest that an environmental factor, most likely asbestos exposure, may damage and transform a group of cells in the tissue, resulting in a population of tumor cells that are, albeit only slightly, genetically different.[citation needed]

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic (chromosome-breaking) and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.[citation needed]

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor- (TGF-) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.[citation needed]

Diagnosis of mesothelioma can be suspected with imaging but is confirmed with biopsy. It must be clinically and histologically differentiated from other pleural and pulmonary malignancies, including reactive pleural disease, primary lung carcinoma, pleural metastases of other cancers, and other primary pleural cancers.[5] Primary pericardial mesothelioma is often diagnosed after it has metastasized to lymph nodes or the lungs.[4]

Diagnosing mesothelioma is often difficult because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient’s medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma.[14] A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe.[4] For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).[citation needed] However, with primary pericardial mesothelioma, pericardial fluid may not contain malignant cells and a tissue biopsy is more useful in diagnosis.[4] Using conventional cytology diagnosis of malignant mesothelioma is difficult, but immunohistochemistry has greatly enhanced the accuracy of cytology.[citation needed]

Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, an open surgical procedure may be necessary.[citation needed]

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics, such as breast or lung cancer that has metastasized to the pleura. There are numerous tests and panels available, but no single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant. The positive markers indicate that mesothelioma is present; if other markers are positive it may indicate another type of cancer, such as breast or lung adenocarcinoma. Calretinin is a particularly important marker in distinguishing mesothelioma from metastatic breast or lung cancer.[5]

There are three main histological subtypes of malignant mesothelioma: epithelioid, sarcomatous, and biphasic. Epithelioid and biphasic mesothelioma make up approximately 75-95% of mesotheliomas and have been well characterized histologically, whereas sarcomatous mesothelioma has not been studied extensively. Most mesotheliomas express high levels of cytokeratin 5 regardless of subtype.[5]

Epithelioid mesothelioma is characterized by high levels of calretinin.[5]

Sarcomatous mesothelioma does not express high levels of calretinin.[5]

Other morphological subtypes have been described:

Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.[49]TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged IaIV (one-A to four) based on the TNM status.[49][50]

Mesothelioma can be prevented in most cases by preventing exposure to asbestos. The US National Institute for Occupational Safety and Health maintains a recommended exposure limit of 0.1 asbestos fiber per cubic centimeter.[24]

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[51] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[52]

Mesothelioma is generally resistant to radiation and chemotherapy treatment. Long-term survival and cures are exceedingly rare.[5] Treatment of malignant mesothelioma at earlier stages has a better prognosis. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient’s age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.[53]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[54] However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008), or with one of the latter. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.[citation needed] In localized pericardial mesothelioma, pericardectomy can be curative; when the tumor has metastasized, pericardectomy is a palliative care option. The entire tumor is not often able to be removed.[4]

For patients with localized disease, and who can tolerate a radical surgery, radiation can be given post-operatively as a consolidative treatment. The entire hemithorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations. It can also induce severe side-effects, including fatal pneumonitis.[55] As part of a curative approach to mesothelioma, radiotherapy is commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.[citation needed]

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy, when given alone with curative intent, has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be beyond human tolerance.[citation needed] Radiotherapy is of some use in pericardial mesothelioma.[4]

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma[56] previously and were not candidates for more aggressive “curative” surgery.[57] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.[citation needed] Cisplatin and pemetrexed together give patients a median survival of 12.1 months.[5]

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[58]

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.[citation needed]

In pericardial mesothelioma, chemotherapy – typically adriamycin and/or cisplatin – is primarily used to shrink the tumor and is not curative.[4]

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Gurin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.[citation needed]

This technique is used in conjunction with surgery,[59] including in patients with malignant pleural mesothelioma.[60] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. High concentrations of selected drugs are then administered into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.[citation needed]

All of the standard approaches to treating solid tumorsradiation, chemotherapy, and surgeryhave been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (314 years) among patients with favorable prognostic factors.[61] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).[54] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation namely depends on the size of the patient’s tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.[62] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.[63] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral (same side) diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.[64]

Mesothelioma often has a poor prognosis. Typical survival despite surgery is between 12 and 21 months depending on the stage of disease at diagnosis with about 7.5% of people surviving for 5 years.[65]

Women, young people, people with low-stage cancers, and people with epithelioid cancers have better prognoses.[5] Negative prognostic factors include sarcomatoid or biphasic histology, high platelet counts (above 400,000), age over 50 years, white blood cell counts above 15.5, low glucose levels in the pleural fluid, low albumin levels, and high fibrinogen levels. Several markers are under investigation as prognostic factors, including nuclear grade, and serum c-reactive protein. Long-term survival is rare.[46]

Pericardial mesothelioma has a 10-month median survival time.[4]

In peritoneal mesothelioma, high expression of WT-1 protein indicates a worse prognosis.[5]

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year.[66] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[67] Worldwide incidence is estimated at 1-6 per 1,000,000.[5] Incidence of mesothelioma lags behind that of asbestosis due to the longer time it takes to develop; due to the cessation of asbestos use in developed countries, mesothelioma incidence is expected to decrease.[24] Incidence is expected to continue increasing in developing countries due to continuing use of asbestos.[5] Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.[citation needed] Less than 5% of mesotheliomas are pericardial. The prevalence of pericardial mesothelioma is less than 0.002%; it is more common in men than women. It typically occurs in a person’s 50s-70s.[4][68]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[69] Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women.[citation needed] More than 80% of mesotheliomas are caused by asbestos exposure.[5]

The incidence of peritoneal mesothelioma is 0.53.0 per million per year in men, and 0.22.0 per million per year in women.[70]

Mesothelioma accounts for less than 1% of all cancers diagnosed in the UK, (around 2,600 people were diagnosed with the disease in 2011), and it is the seventeenth most common cause of cancer death (around 2,400 people died in 2012).[71]

The connection between asbestos exposure and mesothelioma was discovered in the 1970s. In the United States, asbestos manufacture stopped in 2002. Asbestos exposure thus shifted from workers in asbestos textile mills, friction product manufacturing, cement pipe fabrication, and insulation manufacture and installation to maintenance workers in asbestos-containing buildings.[24]

Mesothelioma, though rare, has had a number of notable patients:

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote “The Median Isn’t the Message”,[74] in which he argued that statistics such as median survival are useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to cancer not linked to his mesothelioma.

Paul Kraus, diagnosed in 1997, is considered the longest currently living (as of 2016) mesothelioma survivor in the world.[75]

Some people who were exposed to asbestos have collected damages for an asbestos-related disease, including mesothelioma. Compensation via asbestos funds or class action lawsuits is an important issue in law practices regarding mesothelioma.[citation needed]

The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.[76] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.[77] In 2013, the “Furthering Asbestos Claim Transparency (FACT) Act of 2013” passed the US House of representatives and was sent to the US Senate, where it was referred to the Senate Judiciary Committee.[78] As the Senate did not vote on it before the end of the 113th Congress, it died in committee. It was revived in the 114th Congress, where it has not yet been brought before the House for a vote.[79]

The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. In 1960, an article published by Wagner et al. was seminal in establishing mesothelioma as a disease arising from exposure to asbestos.[80] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.[81] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[82] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.[citation needed]

In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.[citation needed]

Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called “Is this Killer in Your Home?” in Australia’s Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, “The Health Hazard at Wittenoom”, containing the results of air sampling and an appraisal of worldwide medical information.[citation needed]

By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.[citation needed]

In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company’s factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.[83]

The WT-1 protein is overexpressed in mesothelioma and is being researched as a potential target for drugs.[5]

Mesothelioma at DMOZ

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Mesothelioma – Wikipedia

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma is a rare, aggressive form of cancer that primarily develops in the lining of the lungs (pleural mesothelioma) or the abdomen (peritoneal mesothelioma). Caused by asbestos, mesothelioma has no known cure and has a poor prognosis.

Learn more about various topics related to mesothelioma below, and follow the links for additional information on each subject.

When diagnosed with mesothelioma, the prognosis is usually poor, as there is no cure for the disease, and typically it is discovered at a late stage of development. Generally, the earlier mesothelioma is diagnosed, the better prognosis a patient has.

The following additional factors can have a significant impact on the prognosis of mesothelioma. A good doctor should be able to give you an honest assessment when all have been identified and considered.

While prognosis is generally poor, there is still hope of survival. For example, Heather Von St. James is a 10-year mesothelioma survivor who has become an advocate for mesothelioma awareness and an outspoken proponent of banning asbestos. Other mesothelioma survivors have shared their stories, which can inspire those who have mesothelioma.

There are two ways to categorize the type of mesothelioma a person has. The first is by where the tumors are found in the body. (Pleural mesothelioma is found in the lungs, peritoneal mesothelioma is found in the abdomen, and percardial mesothelioma is found in the heart. The second way to categorize mesothelioma is by the three types of possible cell structure the cancer may have: (epithelioid, sarcomatoid, or biphasic).

Mesothelioma is most commonly classified by the location in the body where it develops. Specifically, the cancer forms in the lining of certain organs or spaces within the body, known as the mesothelium. Mesothelioma typically develops in one of three specific areas.

The most common type, pleural mesothelioma is caused by the inhalation of asbestos fibers.

Inhaled or swallowed asbestos fibers can become trapped in lining of the abdomen (the peritoneum).

In rare cases, asbestos fibers can get lodged in the pericardium, the lining around the heart cavity.

Mesothelioma most commonly forms (between 80 to 90 percent of the time) in the pleura of the lungs as shown below:

As a rare form of cancer, diagnosing mesothelioma can be a long, complex, and often frustrating process, and the disease is often misdiagnosed. Doctors rely on the symptoms of the patient as well as various types of tests to diagnose mesothelioma.

The symptoms associated with mesothelioma can often look like conditions related to other diseases, which makes it very difficult to diagnose. Some common symptoms of mesothelioma include:

Typically, doctors will try to diagnose the disease by eliminating other potential or related diseases and conditions first. This often involves a variety of tests that provide differing levels of information from which to make a determination about the disease.

Imaging tests can include x-rays, CT scans, PET scans, and MRIs, each of which provide a different level of sight into the body without using surgical methods. Because they are non-invasive, these types of imaging tests are often the first forms of diagnostic tool used in detecting mesothelioma.

In some cases, mesothelioma may be able to be detected through the use of certain blood tests that look for biomarkers unusual substances in the blood that can indicate a particular condition. While no definitive mesothelioma biomarker test exists, these tests could eventually lead to earlier detection than currently exists.

Collecting tumor tissue through a biopsy is usually one of the last mesothelioma tests to be taken. While it is the most reliable test, it can also be the most invasive, which is why doctors tend to wait until they have ruled out other diseases through other tests before taking a biopsy.

Upon a diagnosis of mesothelioma, the doctor will categorize the disease into one of four stages. While there are several staging systems, the TNM System which stands for tumor, lymph nodes, and metastasis is the most commonly used.

Stage 1

The mesothelioma tumor is located in only one area and has not spread to other parts of the body.

Stage 2

A large tumor may have progressed to nearby areas and/or the lymph nodes, but has not gone on any further.

Stage 3

Tumors have typically spread beyond the local area to several nearby locations and the lymph nodes.

Stage 4

The tumors have spread into multiple areas and throughout the lymphatic system, invading other organs throughout the body.

Typically, Stage 1 and Stage 2 mesothelioma can be treated effectively with surgery and other forms of therapy. However, Stage 3 and Stage 4 mesothelioma are often treated palliatively (i.e., to relieve pain rather than in an attempt to cure the disease).

Once an individual has been diagnosed by a qualified mesothelioma doctor and the disease has been appropriately staged, the next step is to discuss mesothelioma treatment options and to develop a treatment plan. Although no cure for mesothelioma exists, several standard therapies are available. In some cases, these treatments can improve the patients prognosis, extending their lives significantly.

For late-stage mesothelioma patients, these treatments may be used palliatively to reduce pain and discomfort caused by the symptoms of mesothelioma.

For patients with an early-stage mesothelioma diagnosis, surgery can be used to remove all or most of the tumor(s). Depending on the tumor location, surgery may include removing the mesothelial lining, one or more lymph nodes, or part or all of a lung or other organ.

Chemotherapy drugs work by attacking fast-growing cells, such as cancer cells. Often used in conjunction with surgery, chemotherapy can kill any remaining mesothelioma cells that the surgeon was unable to remove physically.

Through the use of targeted radiation, mesothelioma tumors can often be shrunk, making them easier to be removed through surgery. Depending on the tumor location, the radiation can be delivered using an external or an internal source.

Many treatment plans use an approach known as multimodal therapy, which employs two or more of these treatment methods in combination.

Depending on various factors such as the patients age, tumor location, cell type, staging, and other considerations, some patients may be eligible to participate in a clinical trial. These trials test new and emerging treatments that could ultimately lead to much better therapy options and potentially even a cure.

Once diagnosed with mesothelioma, a patient will likely need to visit with a variety of specialists. These visits may require travel, as the number of doctors who focus on mesothelioma is rather small. There are also some cancer centers dedicated specifically to mesothelioma treatment and research.

Oncologists are doctors who focus on preventing, diagnosing, and treating cancer. Since the most common type of mesothelioma is pleural mesothelioma, the majority of patients will work with a thoracic oncologist, who specializes in cancers that form in the chest.

Mesothelioma clinics and cancer centers throughout the country offer patients a way to get the most comprehensive care, often using the latest technology and techniques available. The National Comprehensive Cancer Network designates these centers as demonstrating excellence in cancer care.

The only known cause of mesothelioma is exposure to asbestos. A naturally occurring mineral, asbestos was once used for its fire- and heat-resistant properties, and it can still be found across the country in many different places, including older homes, schools, public buildings, and worksites. Asbestos is not banned, but its use in the U.S. is limited to certain types of products.

While asbestos is the primary cause of mesothelioma, other risk factors can increase the potential for developing the disease.

If you or someone you know has mesothelioma, these resources offer additional information about getting assistance.

Get help caring for your loved one who has mesothelioma, including information about long-term care, counseling services, and taking care of your own needs as well.

The costs associated with treating mesothelioma can be significant. In many cases, individuals diagnosed with mesothelioma who were exposed to asbestos are eligible for financial compensation from asbestos manufacturers for their illness. Financial assistance is available to help offset the high cost of mesothelioma treatment.

Mesothelioma is caused by exposure to asbestos. If this exposure occurred in a workplace, public building, school, or through the use of an product that contained asbestos, you may be able to receive compensation for medical bills, lost wages, and other related expenses. Learn more about your legal rights.

National Cancer Institute Malignant Mesothelioma (Source)

Wagner, J.C., Sleggs, C.A., and Marchand, Paul. Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province. Department of Thoracic Surgery: University of The Witswatersrand. Johannesburg, South Africa. 1960.

Grondin, Sean C., Sugarbaker, David J. Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma Chest December 1999 116:suppl 3 450S-454S;

Rusch, Valerie W. Indications for pneumoctomy. Extrapleural pneumonectomy

Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT (2002). “Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases”. Ultrastruct Pathol 26(2): 5565.

Brigham and Womens Hospital International Mesothelioma Program (Source)

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Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma Symptoms – Mayo Clinic

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

Pleural mesothelioma, which affects the tissue that surrounds the lungs, causes signs and symptoms that may include:

Peritoneal mesothelioma, which occurs in tissue in the abdomen, causes signs and symptoms that may include:

Signs and symptoms of other types of mesothelioma are unclear, since these forms of the disease are very rare.

Pericardial mesothelioma, which affects tissue that surrounds the heart, can cause signs and symptoms such as breathing difficulty and chest pains.

Mesothelioma of tunica vaginalis, which affects tissue surrounding the testicles, may be first detected as swelling or a mass on a testicle.

See your doctor if you have signs and symptoms that may indicate mesothelioma. Signs and symptoms of mesothelioma aren’t specific to this disease and, due to the rarity of mesothelioma, are more likely to be related to other conditions. If any persistent signs and symptoms seem unusual or bothersome, ask your doctor to evaluate them. Tell your doctor if you’ve been exposed to asbestos.


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Mesothelioma Symptoms – Mayo Clinic

Mesothelioma – Overview of Malignant Mesothelioma Cancer

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Malignant mesothelioma is a rare, asbestos-related cancer that forms on the thin protective tissues that cover the lungs and abdomen. A combined approach to treatment is helping people improve their survival and ease symptoms.

Or watch our video on mesothelioma

Dr. Jacques Fontaine, world-renowned mesothelioma specialist, sits down and talks about mesothelioma exclusively with Asbestos.com.

Did you know that doctors diagnose an estimated 3,000 cases of mesothelioma annually in the U.S.? The majority of those are traced to job-related exposures to asbestos. Most people have the pleural type, which forms on the lining of the lungs, but the cancer can also form around the lining of the abdomen or heart.

Although asbestos use in this country has dropped in recent decades, a steady number of people are still getting mesothelioma. That’s because this cancer can take anywhere from 20 to 50 years after asbestos exposure before symptoms appear, and an oncologist can make a definitive diagnosis.

While there’s no cure for mesothelioma and the outlook is generally poor, researchers have made significant progress in understanding the cancer and developing new treatment options and alternative therapies.

Mesothelioma typically develops after people are exposed to asbestos in the workplace in industrial settings, shipyards, auto repair shops, old houses, schools and public buildings. While it usually takes long-term exposure to put someone at risk, short-term and one-time exposures are also known to cause this cancer.

Fast Fact: 70-80 percent of people with mesothelioma were exposed to asbestos at work.

Asbestos can cause health complications when work duties or other activities disturb asbestos-containing materials and release fibers into the air. When we inhale or swallow these microscopic fibers, our bodies struggle to get rid of them. Over decades, the trapped fibers trigger biological changes that can cause inflammation, scarring and genetic damage that sometimes leads to cancer. The lengthy gap between asbestos exposure and diagnosis is called the latency period.

Asbestos fibers most often become trapped in the lining of the lungs, called the pleura. They also can collect in the lining of the abdominal cavity (peritoneum) or heart (pericardium). Once fibers cause biological damage, the stage is set for the decades-long latency period for the development of malignant mesothelioma.

Although several factors help determine your prognosis, or survival outlook, it is most affected by the stage of your cancer. Your doctors will perform tests to determine your cancer stage, typically a number I-IV that describes the seriousness of your diagnosis. Your cancer stage helps doctors determine the treatment options likely to work best for you.

Pleural mesothelioma is the most common type of the disease, representing about 75 percent of all diagnoses. Peritoneal is the second most common type, accounting for 10 to 20 percent of diagnoses. Approximately 1 percent of cases are of the pericardial variety. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

Mesothelioma symptoms can be so mild that few people notice or recognize them, and many don’t experience any of them until later stages of the cancer. Fatigue and slight pain around the tumor may surface in early stages. Late-stage symptoms are more noticeable and commonly provoke people to visit the doctor.

These late-onset signs can include shortness of breath, chronic pain near the tumor, weight loss, fluid buildup or bowel obstruction. Effective therapies can relieve symptoms, and some treatments, like talc pleurodesis, can even prevent symptom recurrence.

Doctors use several methods to test for malignant mesothelioma. Some exams provide more information than others, such as imaging scans and biopsies, but a combination of these helps doctors confirm an accurate diagnosis.

Most people initially undergo a basic chest X-ray to check for any abnormalities. If an abnormal growth is detected, doctors will recommend a more detailed imaging scan such as a PET scan, CT scan or MRI.

If cancer is suspected, doctors will recommend taking a sample of tissue, also knowns as a biopsy. Doctors use this tissue sample to definitively confirm the presence of mesothelioma cells.

Blood tests are also available, but they do not confirm the presence of mesothelioma. Research and development is underway to determine if blood tests can aid in early diagnosis for at-risk former asbestos workers.

There are at least five staging systems doctors use to stage pleural mesothelioma. The most widely used is the IMIG staging system. There are currently no universal staging systems for the cancer’s other types.

Despite the often poor prognosis associated with malignant mesothelioma, there are a number of encouraging stories of success accounts of people who live to celebrate special days with spouses, kids and grandkids. Each survivor has a unique tale to tell.

“We needed the right information so that we could be prepared, so we could understand what we would be going through, what we needed to do.”

“We’re very fortunate to know the Veterans Department and the whole team at Asbestos.com. We were in dire straits, and they gave us hope.”

“So much support made me realize I wasn’t alone in this fight. This is a path you don’t want to try and walk alone. You have to let others into your life.”

“I can’t do everything I once could, but I’m still out there getting around. I was fortunate in the care I received. And I don’t mind sharing my good fortune.”

“When you are diagnosed, don’t listen to the doom and gloom. Fight with all your might. Don’t worry if you feel selfish, as you are important.”

“I don’t dwell on this disease. I try to forget what I have. It just taps me on the shoulder and lets me know when I climb stairs, or walk too fast and get out of breath.”

The leading treatment options for mesothelioma include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, an approach known as multimodal therapy. Clinical trials show this approach has improved survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages, and experimental therapies like immunotherapy show progress for the future. Additionally, many survivors tout less-traditional alternative treatments for helping them to live longer.

Curative surgery is available for people with early stage mesothelioma, while palliative surgery is best for easing the symptoms of those diagnosed at a later stage.

Chemotherapy is a standard treatment to kill cancer cells, shrink tumors, prevent recurrence and relieve symptoms.

Radiation therapy is used alone or in combination with chemotherapy or surgery to kill cancer cells, manage tumors and prevent cancer from spreading along the path of a biopsy incision.

Mesothelioma specialists encompass a number of specialties, including surgery, medical and radiation oncology, radiology, pathology and palliative care. All can be part of a patients treatment plan. Working with an experienced mesothelioma doctor can make all the difference.

Get Help Finding a Specialist

The most-regarded treatment centers attract people from across the country. Renowned for their cutting-edge technology and groundbreaking research, these centers can connect you with a multidisciplinary team of physicians with years of experience in treating asbestos-related diseases.

Get Help Finding a Cancer Center

Treatment is expensive, and insurance companies may not cover the cost of diagnostic tests or experimental therapies. People without medical insurance will face an even harder battle. If you or a loved one is diagnosed, consider taking steps to protect your finances.

Financial expert and Patient Advocate Manager Joe Lahav knows the ins and outs of all the financial aid options available to you, including mesothelioma trust funds and grants to cover travel, treatment, housing and other expenses. Let him review your information and determine if you qualify for free financial assistance.

Many people with mesothelioma seek legal help to recoup medical expenses and secure a financial future for their families. Mesothelioma and other asbestos-related diseases are entirely preventable, but the companies that mined, manufactured and sold asbestos products put profits before the health of customers and their own employees. Our legal system ensures these companies are held accountable for their negligence.

Fast Fact: A 2011 report from the Government Accountability Office reported that $36.8 billion remained in asbestos trusts. This money was set aside to help compensate victims of asbestos exposure and their families.

People who were injured by asbestos can seek legal help through an established asbestos trust fund or by filing a lawsuit against the companies responsible for their asbestos exposure. Trust fund benefits, winning legal claims or out of court settlements can help you and your family cover treatment, lost wages and other expenses.

Manufacturers that used asbestos could have prevented their workers and others from getting exposed to the deadly mineral. Filing a lawsuit can ensure they are held financially responsible for their negligence.

The outcome of an asbestos-related lawsuit can vary because each case comes with its own set of facts, but juries have returned with verdicts of $337 million (for Alfred Todak), $30.3 million (for Susan Buttitta) and $22 million (for Eugene McCarthy and Walter Koczur).

Most asbestos-related lawsuits are settled out of court before they to go trial. A paper trail of occupational exposure can lead defendants to settle out of court to avoid lawsuit expenses as soon as possible. Settlements can range from moderate to large sums.

Because asbestos use in the military was so rampant from 1940 to 1980, veterans from all branches of the U.S. Armed Forces who served during those years are now at high risk of developing mesothelioma and other asbestos-related conditions. Job duties known for high rates of harmful exposures include pipefitting, mechanical work, equipment maintenance and shipyard work.

If you or a loved one was injured by asbestos exposure in the military, U.S. Army Capt. Aaron Munz can help you navigate the VA claims process and get the benefits you deserve. Munz, who joined The Mesothelioma Center as Veterans Department Director in 2015, is a decorated veteran who served nine years in combat and earned the Bronze Star Medal for Valor in 2004 during Operation Iraqi Freedom. He understands the challenges veterans face when diagnosed with mesothelioma, and can answer any questions about the disease and the complicated filing process for VA claims.

Every cancer diagnosis comes with a wide range of physical and emotional challenges, and it’s not just patients who are affected. Sometimes family members and loved ones need support too. We can get you free resources to help you move forward, whether you’re a new caregiver or a concerned spouse or family member.

Request a comprehensive mesothelioma guide to gain a deeper understanding of the cancer and how you can help your loved one in this difficult time. We provide free must-read books that answer frequently asked questions about mesothelioma, too.

Visit our Facebook page for the latest in survivor stories, treatment news and inspirational images. While you’re there, connect with other members of the mesothelioma community who understand exactly what you’re going through.

Order a free wristband today to support your loved one. By wearing a mesothelioma wristband you can help bring awareness to this deadly cancer and also bring to light the dangers of asbestos exposure. Order today and have them shipped overnight.

Learn how to help your loved one cope with mesothelioma by participating in our monthly support group. You can participate online or over the phone to watch a presentation by our licensed mental health counselor, Dana Nolan, and share your experiences with other survivors and caregivers.

View our resources for patients and families

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Mesothelioma – Overview of Malignant Mesothelioma Cancer

Malignant MesotheliomaPatient Version – National Cancer …

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the thin layer of tissue that covers the lung, chest wall, or abdomen. It may also form in the heart or testicles, but this is rare.

The type of malignant mesothelioma depends on the cell in which it began. The most common type of malignant mesothelioma is epithelial mesothelioma, which forms in the cells that line organs. The other types begin in spindle-shaped cells called sarcomatoid cells or are a mixture of both cell types. Epithelial mesothelioma may grow more slowly and have a better prognosis than other types.

The major cause of malignant mesothelioma is being exposed to asbestos over a period of time. This includes people who were exposed to asbestos in the workplace and their family members.

After a person is exposed to asbestos, it usually takes at least 20 years for malignant mesothelioma to form.

Malignant mesothelioma forms in the thin layer of tissue that covers the lung, chest wall, abdomen, heart, or testicles.

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Malignant MesotheliomaPatient Version – National Cancer …

Mesothelioma | Overview, Treatment Options and Survivor Stories

Malignant mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body’s internal organs, known as the mesothelium.

There are three recognized types of mesothelioma. Pleural mesothelioma is the most common form of the disease, accounting for roughly 70% of cases, and occurs in the lining of the lung known as the pleura. Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma originates in the pericardium, which lines the heart.

An individual may be at risk to develop mesothelioma if he or she was exposed to asbestos in the workplace or at home. Mesothelioma is caused by exposure to asbestos and the inhalation of asbestos particles. In most cases, mesothelioma symptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred. Those with a past asbestos exposure history experiencing symptoms should consult a physician with experience in accurately diagnosing mesothelioma. The earlier mesothelioma is diagnosed, the more likely it is to be caught at an early stage. At earlier stages of mesothelioma progression, more treatment options are available and oftentimes a better prognosis is given.

Additional mesothelioma information and statistics can be found in this section. Read stories of hope from mesothelioma surviviors as well.

Once an individual has been diagnosed by a qualified mesothelioma doctor, the next step is to discuss mesothelioma treatment options and to develop a treatment plan. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing mesothelioma and supporting improved quality of life. Newly diagnosed mesothelioma patients often have many questions for their doctors about the treatment options that would be most effective for them. Conventional treatment options for mesothelioma include surgery, radiation and chemotherapy. Recently, chemotherapy drugs including Alimta and Cisplatin have showed promising results in some patients.

Mesothelioma clinical trials as well as experimental treatments are other options that certain mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We’ve included resources on top mesothelioma experts such as Dr. David Sugarbaker and Dr. Raphael Bueno, as well as a comprehensive list of cancer centers where mesothelioma treatment takes place. Beyond the conventional treatments for mesothelioma, certain alternative therapies may provide assistance to mesothelioma patients. Financial assistance is available to help offset mesothelioma treatment costs. We continually update this section of our site as new mesothelioma treatment information becomes available.

In 2006, at the age of 36, Heather Von St. James gave birth to her daughter, Lily Rose. Just three months later, she was diagnosed with mesotheliomastartling news for someone so young. Heather had been exposed to asbestos second-hand as a child when her father would return home from work with his clothing covered in asbestos dust. Heather often wore his coat, and in the process she unwittingly breathed in the fibers. With strong faith, support from a host of family and friends, and a vibrant sense of humor, Heather emerged from a multi-month course of treatment healthy and cancer-free.

Louise Lou Williams was exposed to asbestos as a child in Australia (where her father was exposed through his work), and also during the three years she worked in a contaminated Melbourne office. Her father died of mesothelioma in 1985, and Lou herself was diagnosed with peritoneal mesothelioma in 2003 following eight years of unexplainable chronic fatigue and a year and a half of being misdiagnosed. After beating that cancer, Lou was diagnosed with pleural mesothelioma in 2009. She now continues her personal fight against mesothelioma while at the same time devoting herself to activism.

Paul Kraus

Paul Kraus has lived with peritoneal mesothelioma for nearly two decades. Born into a Nazi labor camp in Austria, he escaped as an infant with his mother and brother and soon emigrated with his family to Australia. Asbestos is prevalent in Australia, and as a result, the country suffers from some of the highest rates of mesothelioma in the world. Mr. Kraus was exposed as a youth on a summer job he took in 1962. The cancer was latent until 1997 at which time he was diagnosed and given just weeks to live.

Stephen Jay Gould

One of the most popular scientific authors of recent times, evolutionary biologist Stephen Jay Gould, authored more than 20 books on a variety of scientific subjects, and published hundreds of essays in Natural History magazine. Gould lived for twenty years after being diagnosed with mesothelioma in 1982. After his diagnosis, he wrote an essay, The Median Isnt the Message, about his reaction to the news and to the realization that half of all mesothelioma patients died within eight months of diagnosis. His essay has been cited as a source of comfort and hope by many cancer victims.

Asbestos exposure is the primary cause of mesothelioma cancer. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of mesothelioma. Asbestos products were used extensively in the 20th century throughout the United States, in a wide variety of applications. Asbestos companies continued to produce these products even after they were known to be hazardous to workers. These products were responsible for asbestos exposure sustained by the individuals who manufactured them as well as those who used them. Renovation and construction both at home and in schools also poses high risk areas for exposure. People also may have been exposed to asbestos-contaminated talc in baby powder

Many workers were put at risk at commercial and industrial locations including refineries, power plants, steel mills, auto production facilities and large construction sites. Some of the occupations of workers at risk include electricians, plumbers, boilermakers, carpenters, mechanics, machinists and more. Additionally, if you lived with someone who was regularly exposed to asbestos and washed their clothes, you could be at risk for second hand asbestos exposure.

Although rare, mesothelioma affects veterans from all branches of service: Army, Navy, Air Force, Marines and Coast Guard. As mesothelioma has a long latency period and can remain dormant for several decades, veterans who served our country from 1930 through 1980 are just now being diagnosed with the disease.

Navy veterans who worked in navy shipyards and or served on our nation’s aircraft carriers, battleships, destroyers, submarines and warship from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos and are at a high risk for developing asbestos related cancer. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present. Some prominent shipyards where asbestos was prevalent include Brooklyn Navy Yard, Norfolk Navy Shipyard, Long Beach Naval Shipyard and Hunters Point Naval Shipyard. Financial assistance and help with VA Benefits is available to veterans diagnosed with mesothelioma.

Asbestos manufacturers and distributors made a concerted effort to hide the dangers of asbestos from the public, while at the same time profiting heavily from the sale and manufacture of harmful asbestos products. Those suffering from Mesothelioma can seek compensation from the manufacturers of asbestos and asbestos-containing products by hiring a competent mesothelioma lawyer.

When deciding whether or not you should pursue your legal rights, you should think about the following three things. First, asbestos manufacturers had knowledge of the dangers of asbestos and knowingly put hardworking men and women at risk. Second, treatment for mesothelioma can be very expensive. Third, by exercising your legal rights, you can protect your loved ones in the future.

Once you make the decision to pursue your rights, a competent asbestos attorney will maximize recovery from both viable and bankrupt asbestos defendants. Over 65 asbestos trusts have been established holding billions of dollars combined across them. These asbestos trust funds have been set aside to help compensate those workers who have been diagnosed with mesothelioma cancer or other asbestos related diseases. The legal process to compensate mesothelioma victims is not overly burdensome and should be strongly considered to help offset treatment costs and to provide financial security for loved ones.

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Mesothelioma | Overview, Treatment Options and Survivor Stories

Understanding Mesothelioma Caregiver Styles – Asbestos.com (blog)

As my fathers caregiver, Mom had a way that was all her own.

She was attentive and loving, while still supporting his independence. She never patronized him and always expressed desire to attend to his needs.

Mom always made caregiving look easy, but I know how difficult it is to care for someone who has advanced mesothelioma. She had a natural skill for taking care of Dad.

She learned how to be a caregiver through experience. Mom never went to medical school or worked in the medical field. She was a homemaker who loved her husband and children.

Her style of caregiving seemed instinctual she just knew what to do when Dad got sick. I never understood how until I studied psychology.

Doctors study medicine for years to develop their style of practice. They develop a sense of responsibility for their patients, and that helps define their style.

Being a family caregiver is a more personal experience than providing medical care for a random patient. They have a love for family and an inner desire to care for their loved ones.

If a physician develops a style through education, experience and their personality, one might wonder what makes up a caregivers style. Most caregivers dont have formal training that teaches them how to interact with their loved one.

Perhaps family caregivers style is more natural more intrinsic than a doctors learned behaviors.

While researching John Bowlby and Mary Ainsworths attachment theory, I came across an article that explores the significance of attachment styles in caregiving.

Attachment styles are bonds developed during infancy and early childhood through infant and caretaker relationships. This type of bonding serves as a model for future relationships in adult life.

In essence, attachment styles influence how we treat others and how we expect others to treat us.

Most people in the developmental psychology community recognize several styles of attachment, including secure, avoidant and resistant. These childhood bonds may have implications in how caregivers will care for a sick loved one later in life.

Our caregiver style is linked to who we are as a person and how we relate to others.

However, a persons caregiving style doesnt fit neatly into any one category. Rather, the styles represent behavioral tendencies that exist on a more fluid spectrum.

We all have days where we are better equipped to provide for the needs of others and face other times when we could use a little help.

Many caregivers fall somewhere within these styles:

Just as a childs behavior might fluctuate depending on outside influences, so does the behavior of a caregiver.

Stress plays a significant role in caregiver responses. The important thing to remember is communication. Sometimes our loved one might need us to be more attentive. Other times, they might be focused more on maintaining independence.

As caregivers, we need to be flexible and sensitive to their needs.

No one is perfect, not even medical professionals. Our loved ones recognize us as human beings who are providing care from the heart.

Very few family caregivers have professional medical training. They learn from on-the-job experience. They provide care not with precision medical skills, but with their hearts.

Perhaps author Kahlil Gibran captures the spirit of a caregiver best when he writes, You give but little when you give of your possessions. It is when you give of yourself that you truly give.

Caregivers reserve the best of themselves for those they love. There is not a more rewarding relationship than one deepened through caregiving.

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Understanding Mesothelioma Caregiver Styles – Asbestos.com (blog)

Mesothelioma Patients Turn to Cannabis – AlterNet

Photo Credit: The Leaf Online

People have inhaled cannabinoidsfor many generations, from the Scythians through its banby the federal U.S. government, and beyond.

Now we find that patients suffering from mesothelioma cancer can use medicinal marijuana as a means to reduce their troublesome symptoms. Many are beginning to personally explore the helpful aspects of this natural medicine as researchers continue their quest toward a cancer cure.

Mesotheliomaiscancerof the mesothelium, a protective lining found onmost of the bodys internal organs. Three out of every four cases cases of mesothelioma disease begin in the pleural mesothelium of the chest cavity. Mesothelioma can also begin in the abdominal cavity and around theheart.

Some common signs and symptoms of Mesothelioma include coughing, shortness of breath, fatigue, weight loss and poor respiratory function. Most early-stage patients are not aware that they are carrying the cancer or have developed Mesothelioma because its symptoms overlap with many other health conditions.

Increasing appetite

According to theAmerican Cancer Society, marijuana improves a cancer patients appetite. Although the cellular function is still vague, this plant seems to trigger neurons that deal with taste and hunger.

Mesothelioma and other cancer patients need to eat during their treatment because the nutrients boost their fight against the ailment. However, treatment procedures typically cause nausea and a strong feeling to avoid food. Medicinal cannabis can be the answer to an upset stomach.

Reducing overall pain

Some cancer patients report a lot of pain in their bodies both during and after chemotherapy. Pain is incredibly debilitating, and it can have ill effects on a patients prognosis. Cannabis is known to dull the pain in the body, which helps anypatient with cancer. Researchers believe that the plant works at the cellular level to block pain signals across the axons. Depending on the cannabiss potency, a patient can feel relaxed for an hour or more with just a little bit of the plant in the body system.

Lifting the mood

When a person fights cancer, a negative mindset can be detrimental to the treatment. Cannabis is known to lift the spirits of anyone taking the substance. The subsequent high allows the person to feel good for an hour or longer. If the person continues to take the substance, this high and positive feeling can be extended. Good moods benefit the person so that they can fight off any more cancer tumors.

Possible ailment relief

TheNational Cancer Institutereports that laboratory test results reflect the direct relationship between declining cancer cells and cannabis use. Although more studies must be conducted, its possible that patients might have some cure to their ailment through this common weed. Patients simply need to inhale or consume the substance in order to see these possible results. Researchers are still concluding whether smoking or eating the cannabis is the best choice. The body must metabolize the substance in different ways, and its possible that eating or smoking it is better or worse for a condition.

Although the federal government still deems this plant as a Schedule 1 controlled substance, many states have medicinal laws that override this rule.Cancer patientsmay want to explore their options with this medicine in order to ease their symptoms. Dealing with cancer is difficult, but it can be tolerable with a natural substance offered through legal pathways.

You can contactVirgil Anderson at[emailprotected]

Virgil Anderson is a mesothelioma patient who blogs about his battle with the disease.

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Mesothelioma Patients Turn to Cannabis – AlterNet

Mesothelioma Survival Rates Slowly Improving – Mesothelioma.net Blog (blog)

One of the most stressful aspects of living with mesothelioma is the fact that the condition carries such a grim prognosis: whether you have been diagnosed with pleural mesothelioma, peritoneal mesothelioma, or the even rarer forms that impact the heart or testicles, most physicians will indicate that the survival rate for the disease is little more than on year. But according to recent reporting by the University of Maryland Medical Centerfollowing a 2016 study, improvements in interventions and treatments have provided an overall median survival rate of almost 3 years. Though this is still a critical diagnosis, it also represents a dramatic improvement for those who have been diagnosed with this disease.

The report followed 73 pleural mesothelioma patients who were treated using a variety of protocols. All of them had surgery to debulk and remove the cancerous tumors, and each was then treated with photodynamic therapy, an innovative treatment approach that uses light and a light-sensitized drug to provide more extensive treatment of cancer cells that remain. Following these two protocols, 92% of patients also received chemotherapy.

This multimodality approach yielded remarkable results. As compared to patients who only had chemotherapy and only lived for 12 to 18 months following treatment, those who receivedall three treatments lived an average of 35 months, and those whose mesothelioma had not yet spread to their lymph nodes lived nearly twice that long.

In addition to this information, other updates in survival and treatment options are revealing growing understanding of the condition. According to a 2015 study published in the Journal of Cardiothoracic, a recent study found that patient survival could reliably be predicted based upon the mesothelioma tumor volume. A study published in theAnnals of Thoracic Surgery revealed a remarkable difference in survival rates betweenwomen and men with mesothelioma, with male patients having a 4.5% survival rate compares to 13.4% in women.

Overall, mesothelioma physicians and advocates are encouraged by the improvements that are being made in patient survival through expanded treatment options, but also feel that the science has a long way to go. For those who are living with mesothelioma on a daily basis, the Patient Advocates at Mesothelioma.net can provide you with updates on available treatments as well as other resources that may help you in your journey. Contact us today at1-800-692-8608.

Terri Oppenheimer is an independent writer, editor and proofreader. She graduated from the College of William and Mary with a degree in English. Her dreams of a writing career were diverted by a need to pay her bills. She spent a few years providing copy for a major retailer, then landed a lucrative career in advertising sales. With college bills for all three of her kids paid, she left corporate America for a return to her original goal of writing. She specializes in providing content for websites and finds tremendous enjoyment in the things she learns while doing her research. Her specific areas of interest include health and fitness, medical research, and the law.

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Mesothelioma Survival Rates Slowly Improving – Mesothelioma.net Blog (blog)

Veterans with Mesothelioma Benefit from Telephone Triage – Asbestos.com

U.S. military veterans with malignant pleural mesothelioma can rely on the VA Boston Healthcare Systems national phone triage for improved access to specialized surgical advice and better treatment recommendations, according to a retrospective study.

Thoracic surgeons Drs. Abraham Lebenthal and Jeff Siegert helped establish the open access telephone triage in 2011, shortening the average time between a veterans initial phone screen and face-to-face surgical consultation to 14 days.

Many veterans facing a potential diagnosis of mesothelioma must navigate the historically mismanaged federal agency to get the treatment they need. Because of difficulties reaching a specialized doctor at the VA, they often settle for less than optimal care, which may lead to shorter survival.

Lebenthal and Siegert hope the telephone triage program will change that.

Open access phone triage for veterans with MPM is possible, enabling timely specialized evidence-based care national, the study shows. We demonstrated that in a federal system, a multidisciplinary team of experts can be assembled and motivated to deliver quaternary centralized care that is typically possible only in a handful of elite teaching hospitals.

Veterans typically are seen first at their local VA health care facility or at an out-of-network medical center. If they suspect pleural mesothelioma is the problem, they can start the process.

The typical telephone triage follows these steps:

The entire telephone triage process, from the veterans first call to the Boston VA final diagnosis, takes an average of 14 days.

The study included 60 U.S. military veterans all men from 26 states who had called the telephone triage for treatment advice about malignant pleural mesothelioma. A dozen more men had called, but they were excluded from the study because they were not U.S. veterans.

All these veterans had already received initial treatment recommendations from their local tumor boards.

After researchers and doctors in Boston gathered and reviewed local test results and confirmed mesothelioma diagnosis, 38 of these veterans traveled to the Boston VA hospital for additional tests.

Once there, treatment recommendations from the Boston VA doctors varied greatly from what the local tumor boards initially suggested.

For example, the local tumor boards suggested 21 patients receive only chemotherapy, but the Boston VA determined only four patients needed that treatment.

Another four patients were initially recommended multimodal therapy, a successful treatment using combinations of radiation, chemotherapy or surgery. But the Boston VA doctors said 29 patients who called the phone triage would benefit from that type of treatment.

Additional tests showed four patients initially diagnosed with the disease didnt even have mesothelioma.

One surprising thing from this study is that we were able to move veterans around the country within the VA system pretty effectively, Siegert said. And for a heckuva lot less money than if you werent a veteran. We used the system already in place, and it worked.

The Boston VA shares staff and facilities with the nearby Brigham and Womens Hospital, which is an elite, multidisciplinary center for mesothelioma patients.

The VA health care system pays for the travel, which is considerably less expensive than sending the patient to a local out-of-network facility. The Boston VA has complimentary housing for its out-of-town patients and families.

By doing everything here, we can bypass a lot of the things that would happen so slowly in the system normally, Siegert said. If a patient gets a first whiff that it could be mesothelioma, we can abbreviate the time vastly, and that pays off for the veteran.

Although the definitive diagnosis, aggressive surgery and aftercare for mesothelioma takes extra staff, effort and knowledge, the Boston VA can simplify the process with its resources already in place at Brigham.

Mesothelioma is a disease so much different than any other, Siegert said. The treatment is so specialized. It requires so much work just to diagnose it, let alone treat it. You cant expect these other facilities to have all that.

One surprising aspect of the study was the nontraditional referral of the patients.

Only 24 percent were referred by a medical provider. The majority used internet resources, such as Asbestos.com, or they were self-referred.

As a physician, I had always gotten patients the old-fashioned way, from other doctors, he said. But thats not the algorithm anymore. Not for this disease.

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Veterans with Mesothelioma Benefit from Telephone Triage – Asbestos.com

Republican Health Care Bill Includes Asbestos Exposure Funding for Libby Residents – Mesothelioma.com

Jillian Duff covers pressing news for the Mesothelioma Cancer Alliance. Bio

March 24, 2017

Libby, Montana – While many people are concerned about the new health care bill supported by Republicans, one provision stands out as a continued benefit for mesothelioma patients and other victims of asbestos exposure. Specifically, a special provision in the proposed piece of legislation, known as the American Health Care Act (ACHA), will provide support to those who live in Libby and were exposed to asbestos from the former W.R. Grace & Co. mine.

It is well known that W.R. Grace Company illegally dumped industrial waste containing large amounts of asbestos at several of their facilities in Libby. The vermiculite it contained is a naturally occurring mineral used in the production of insulating materials. The vermiculite ore also contained tremolite asbestos, which is extremely toxic.

During the mines 70 years of operation, the ore was shipped to more than 50 processing plants throughout North America. Much of the Libby vermiculite was used to produce Zonolite attic insulation, but was also used in surfacing materials, window glazing compounds, waterproofing compounds, cements, adhesives, and plaster.

Senator Steve Daines (R-Montana) was a major factor in the inclusion of this provision in the ACHA. The Affordabla Care Act (ACA), popularly known as Obamacare, included similar medical-care benefits for these patients effective in 2011. The new bill likewise includes ongoing screening and Medicare coverage for those diagnosed with asbestos disease as a result of living or working in Libby.

In 1999, the U.S. Environmental Protection Agency (EPA) launched an investigation of the Libby mines and surrounding communities. Those afflicted with asbestos disease not only included miners and mill workers, but also their families and neighbors who were exposed to ore dust which contained tremolite asbestos. This deadly mineral invaded every aspect of life in Libbyair, water, clothing, and food.

Mesothelioma cancer is one of the asbestos diseases that resulted. Treating this type of cancer is very expensive and the survival rate is poor.

Thousands of people have benefited from the Libby provisions. This includes 4,500 new people being screened for asbestos disease at the Center for Asbestos Related Disease (CARD) clinic with over 2,000 individuals being diagnosed. As many as 1,846 victims under 65 years old have Medicare support as part of these provisions, and around 1,300 people are in the pilot program.

Even with these provisions, however, the ACHA could still be detrimental to mesothelioma patients and their families, especially for those patients who could lose their health care coverage under the new legislation. Outside of Libby, thousands of people each year are diagnosed with mesothelioma and are faced with the need to pay for critical cancer treatment. It is unclear at this point whether the Republicans have enough support to pass the ACHA in the House of Representatives.

Earlier this year, the EPA gave its final call for residents to request asbestos inspections in Libby. Financial assistance was offered in instances where an inspection uncovered the need to clean up asbestos from a property. If not cleaned up, it poses a health risk to even more Libby residents.

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Republican Health Care Bill Includes Asbestos Exposure Funding for Libby Residents – Mesothelioma.com

Pembrolizumab shows promise in treatment of mesothelioma – Science Daily

Pembrolizumab shows promise in treatment of mesothelioma
Science Daily
Malignant pleural mesothelioma is a rare and aggressive cancer that represents about 90 percent of all malignant mesothelioma cases. It's primarily caused by the inhalation of asbestos, a fiber commonly found in some forms of insulation, vinyl floor

and more »

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Pembrolizumab shows promise in treatment of mesothelioma – Science Daily

Diagnosing Pleural Mesothelioma with Lung Fluid: The Battle of the Biomarkers – Surviving Mesothelioma

A biomarker called soluble mesothelin related peptide (SMRP) may be a more reliable way to diagnose malignant pleural mesothelioma from lung fluid than the protein fibulin-3.

That is the finding of Italian researchers who tested the diagnostic performance of the two markers in 120 patients, including 33 mesothelioma patients, in an effort to resolve what they call conflicting data on the two methods.

SMRPs are produced by the breakdown of proteins in the membranes surrounding the lungs, heart, and abdomen. The amount of SMRP in the blood is thought to be related to the extent of malignant mesothelioma in the body.

Fibulin-3 (FBLN) is an extracellular matrix protein expressed in the membranes of blood vessels. A 2012 study published in the New England Journal of Medicine suggested that measuring the amount of FBLN3 in the plasma of people with pleural mesothelioma could help distinguish them from people with pleural effusions not due to mesothelioma.

Subsequent studies, however, have found FBLN3 potentially more useful for predicting how well a patient is likely to respond to mesothelioma treatment, than as a diagnostic tool.

In their new study, cancer researchers with Italys regional health service in La Spezia compared the diagnostic accuracy of FBLN3 and SMRP in patients with excess lung fluid called pleural effusions. The buildup of fluid around the lungs can be caused by a malignancy like pleural mesothelioma or by a non-malignant condition.

To assess how the biomarkers performed in both types of conditions, the research team included 33 patients with malignant pleural mesothelioma, 64 patients with benign tumors on their pleural membranes and 23 patients with other types of cancer that had metastasized to the pleura.

Levels of FBLN3 were similar inpleural effusions from malignant pleural mesothelioma and pleural effusions from other pathologies, writes clinical pathology researcher Enrico Battolla. [This is] in contrast to SMRP levels, which were significantly higher in pleural effusions from malignant pleural mesothelioma.

The team concluded that FBLN3 was not useful as a diagnostic biomarker in the pleural effusions of people with malignant pleural mesothelioma since it was unable to discriminate mesothelioma from other causes of pleural effusions.

SMRP, on the other hand, was determined to be useful, a finding consistent with previous studies. Even with biomarkers for guidance, diagnosing mesothelioma remains a complex process, involving imaging studies, a thorough physical exam, and a careful history of potential asbestos exposure.

FBLN3 is still considered to be a useful mesothelioma prognostic marker. Other biological markers for prognosis include the ratio of neutrophils to lymphocytes in the blood (a measure of how well the immune system is functioning), c-MET expression (associated with blood vessel formation for the tumor), and ki-67 ratios (associated with cancer cell proliferation).


Battolla, E, et al, Comparison of the Diagnostic Performance of Fibulin-3 and Mesothelin in Patients with Pleural Effusions from Malignant Mesothelioma, March 2017, Anticancer Research, pp. 1387-131.

Creaney, J, et al, Comparison of mesothelin and fibulin-3 in pleural fluid and serum as markers in malignant mesothelioma, Mary 26, 2015, Current Opinions in Pulmonary Medicine, Epub ahead of print


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Diagnosing Pleural Mesothelioma with Lung Fluid: The Battle of the Biomarkers


A biomarker called soluble mesothelin related peptide (SMRP) may be a more reliable way to diagnose malignant pleural mesothelioma from lung fluid than the protein fibulin-3.


Alex Strauss

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Diagnosing Pleural Mesothelioma with Lung Fluid: The Battle of the Biomarkers – Surviving Mesothelioma

US Navy Film Reveals Crazy Cold War Chemical Weapons Plans – The National Interest Online (blog)

During the early years of the Cold War, the Pentagon heavily prepared to useand defend againstnew and improved poison and germ weapons.

Now we have detailed look at those plans from a newly declassified 1952 U.S. Navy training film. Earlier in October 2015, the independent website GovernmentAttic.org posted an electronic copy of the footage. A private individual had requested the footage 15 years ago via the Freedom of Information Act.

Biological and chemical warfare have two principle objectives, the films narrator says, to reduce food by destroying his crops and his food-producing farm animals and to incapacitate the enemys armed forces and that portion of his human population that directly supports them.

This clinical and disturbing description of wreaking chemical and biological death on an opponent is accompanied by images of fields, pigs and marching Soviet troops.

The U.S. Naval Photographic Center produced the film to explain how the military planned to deliver deadly chemicals and diseases, and protect its own sailors from similar attacks. The narrator describes the results of experiments thatif they had involved real chemical weaponswould have resulted in the deaths of thousands of people. The film also details equipment designed to spray toxic particles from airplanes, ships, submarines and more.

The Pentagon put the U.S. Army in charge of cooking up the specific agents and producing them in sufficient quantities, the narrator notes. Originally formed as the Chemical Warfare Service in 1918 during World War I, the Armys Chemical Corps researched dozens of possible payloads.

The ground combat branch already had decades of experience with gases like mustard and phosgene that burn the skin and attack the lungs. The United States and the Soviet Unionas well as other allied powers on both sidesappropriated work Nazi Germany had done on organophosphates that strike the central nervous system and prevent a persons brain from communicating properly with their vital organs.

The same year the Navy produced the film, scientists in the United Kingdom invented a new nerve agent codenamed Purple Possum. After learning of the weapon, the U.S. Army started producing the substance with its own moniker, VX. On top of that, the Chemical Corps explored the possibility of weaponizing various bacteria, viruses and toxins. Pentagon experiments included work on anthrax, bubonic plague, smallpox and ricin, among others.

Lastly, as alluded to in the Navy films introduction, the Army considered various chemical and biological agents that could specifically kill crops and livestock. As a result, the Pentagon had an advanced defoliation program well before it sprayed gallons of Agent Orange over Vietnamese jungles.

With the Army in charge of these terrifying chemicals, the Navy focused its efforts on the delivery systems. The film describes weapons dispersed from ships, dropped or sprayed from airplanes or released by submarines.

According to the narrator, the Navy conducted its first ship-borne tests two years earlier in 1950. A rather crude spraying system was installed on a mine layer, which secretly cruised off California and sprayed some 50 gallons of biological stimulant along a track two-to-five miles off shore, the narrator says.

The Pentagon regularly used non-threatening bacteria or spores to secretly test how far a real germ weapon would spread. In this experiment, as in the case with chemical and biological weapons in general, weather patterns and the terrain largely dictated where the particles went.

During the California test, technicians used special collectors to determine that the spray covered some 48 square miles of total area. Had an infectious agent been used in the spray, there might have been 210,000 casualties, the narrator says.

In April 1952, the minesweeper USS Tercel sprayed more simulated toxins along the coasts of North Carolina, South Carolina and Georgia. The rather flat terrain would be favorable to wide dispersion of wind-borne particles, the narrator says in the film.

Tercel sprayed 250 pounds of zinc cadmium sulfide during an eight-hour voyage along some 100 miles of coastline. Evaluators later found evidence of the fluorescent material across 20,000 square miles spread over all three states.

But surface ships such as the Tercel would be vulnerable to attack during an actual war. Recognizing this vulnerability, the Navy planned to mount sprayers on submarines for actual operations.

After reaching periscope depth, the submarines wouldas the concept wentvent their deadly payloads into the atmosphere. If everything went according to plan, the vessels would then submerge and escape without anyone on land knowing the attack had even happened until it was too late.

The Navy also worked on underwater chemical and biological mines. A sub would lay these devices along the ocean floor and then leave the area. After a predetermined time had passed, the mine would float to the surface. A tube would then pop out of the top and release its gas or germs. Aircraft could carry the same weapons and drop them into lakes and rivers further inland.

Alternatively, an airplane with a giant spray tank could do the job. At the time, bombs loaded with noxious chemicals were hardly new, but spray tanks would be more effective and accurate for seeding large amounts of toxic agents.

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US Navy Film Reveals Crazy Cold War Chemical Weapons Plans – The National Interest Online (blog)

It’s 1985 all over again: To me, the Reagan years were a time of death and Trump’s era feels eerily similar – Salon

Since Novembers presidential election, I have had an uneasy feeling of dj vu. It took me a while to put my finger on exactly what I was remembering. Until I realized, its 1985. Now, just as then, we are living in a time when the presidents actions are leading to harm for marginalized people around the world.

My vantage point on 1985 is that I grew up in the 1980s in New York City in the midst of the AIDS epidemic. It was likely during the latter part of the decade that I acquired HIV.

I have lived with HIV for about 30 years, and yet this disclosure is a new one for me to offer in my professional life. I am a university president who has been out as a gay man across my career, but up until now, disclosure about my HIV status has been on a need-to-know basis.

Why am I making it public now? Because of the parallels between then and now. In 1985, the president not speaking one particular word caused us injury and death. In 2017, the president speaking many incendiary words is causing injury and death.

It is difficult to explain what 1985 was like for me, when todays prevailing narrative about the Reagan years and the 1980s is fond nostalgia. Fondly is not how I remember the 1980s. Sickness and death were everywhere around me.

I did not get tested when the HIV test became available in 1985, because no treatment was available and because I was scared. But I was sure I had acquired the virus that was revealing itself across my friendship and partner circles.

The government knew an epidemic was raging through marginalized communities, and public health strategies were available, but government policy reflected indifference and inaction. President Reagan did not say the word AIDS until 1985, after more than5,000 known AIDS deaths in the United States, and well after the scope of the coming pandemic was understood.

I was certain as were many gay men that few cared if we all died, because we heard those words often and from many. I believe the vitriol and volume of the hate speech of the 1980s has receded from most peoples memory. It has not receded from mine: I believed then that dying from AIDS was simply part of being gay.

Today, I wonder whether many immigrants and many people who might look like immigrants feel now how I felt in the 1980s. I cannot know the contemporary experience of many marginalized groups, but I can imagine that many people Muslims, women, people living with disabilities, people of color standing up against institutionalized racism, people at the intersection of these and many more identities feel as abandoned by the state as I felt then.

The parallels between then and now are why I am disclosing my HIV status publicly. My status and my story are what I have to offer. We saved our community from extinction in the face of government-sanctioned indifference, hatred and oppression. I not only survived the plague, but have achieved some level of success, as a university president, perhaps in part because of what I learned in surviving.

To be clear: We did not beat or cure AIDS in the 1980s. Many of us died across a protracted fight with society and the government. Our success was more for gay white men than it was for women, people of color and people living in poverty and prisons. And millions around the world continue to acquire, live with and die of AIDS in the shadow of indifference, hatred and oppression. But we secured a specific and significant success, and I am here to tell about it.

Others have documented how Gay Mens Health Crisis (GMHC) and ACT UP forced the government to respond to the public health crisis of HIV. My story is that I participated in that solution as a young person.

In 1985, I was 20. I expected to die within a few years. I felt powerless amidst sickness and death, anticipated symptoms and illness on any given morning, and yearned for an outlet for my sadness and anger. Fortunately there were wise elders to tell me what to do. I did not fully understand what I was doing when I volunteered or went to a protest. I was simply doing what those elders who led GMHC and ACT UP told us to do without appreciating the leadership, strategy and focus of our advocacy and political action.

The orchestrated posing of hundreds pretending to be dead in front of federal buildings, the relentless closing down of traffic and commerce, the messaging that straight people could not ignore I participated in these actions, gradually understanding them as a solution, and sometimes choosing them over less productive behaviors that a kid pursues if he believes hes living under a death sentence.

I find myself back in the 1980s as I listen to President Trump. But Im not a kid. I am instead the product of schooling by wise elders and by 30 years of HIV.

I do ask myself why I didnt disclose more publiclyuntil now. My list of answers is long and psychologically revealing: fear of repercussions (many real, some imagined), a desire not to be pitied or summed up by my status, a need to focus on others and to be useful, my own internalized heterosexism and homophobia, a need to remain private in a very public job.

Or, perhaps its that I was waiting to use this asset of mine when its most needed.

Students at my university a university thatis explicitly focused on social justice ask me what to do right now. Black and brown students ask how to stand up to hate and violence. Queer students ask what it means that the Department of Education is led by someone who has supported discrimination and conversion therapy. Students ask how to translate their passions into actions that will matter. I realize they think Im an elder who has answers, and I see theyre more ready than I was in the 1980s. I realize too I have some answers that Ive learned from the successes and failures of the 1980s lessons about leadership, strategy and focus of advocacy and political action. I know how to fight for my life and an oppressed community and how to win.

Recently, Larry Kramer, one of the founders of GMHC and ACT UP, offered observations similar to mine. He said, Its the early days of AIDS all over again. I didnt think this would ever happen. It makes you want to cry.

Ive cried too, Mr. Kramer. And Ive paid attention. My tears are dry, and Im ready. We have precedent and the credentials to secure social justice.

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It’s 1985 all over again: To me, the Reagan years were a time of death and Trump’s era feels eerily similar – Salon

Where I stand on the Confederate flag controversy – Virginian-Pilot

Combat in the Civil War may have ended in 1865, but the passions the war evoked still flare.

Witness the story some days back about a Richmond group encouraging display of the Confederate battle flag on private property.

I dont claim to be an expert on the Civil War, but its the subject I have most read about for more than 60 years.

To many thousands of Virginians, the flag is a salute to the armies in gray. To thousands of others, it honors a kinsman who fought in that war.

But at issue here is the fact that to thousands of Virginians, that flag is deeply offensive because it symbolizes slavery.

When Eli Whitney invented the cotton gin, he made cotton the basis of the Souths economy. Growing cotton is labor-intensive, and slave labor became an important part of the industry.

As the 1800s passed, the culture of the North became industrial and the culture of the South became agricultural. That created an economic and emotional gulf.

Meanwhile, slavery became more and more of a flint, creating sparks of opposition and defense. The sparks finally burst into flame with the election of Abraham Lincoln and the attack on Fort Sumter in Charleston. Over the years, there had been compromises to satisfy both the Souths economic desire for the institution of slavery and the Norths opposition to it. Why then, did war break out?

It was a matter of states rights, Southerners said. For some it was a revolt against an oppressive government as the American Revolution had been. Fact: the sole issue, the ultimate cause, the touchpoint that made the Civil War necessary, was slavery. It was beyond compromise and only combat could solve it.

Lincolns first objective in going to war was not to free the slaves but to save the union. He issued the Emancipation Proclamation because he saw that there needed to be a moral basis for the war. Anti-black prejudice was strong in both the North and South, so there were countless numbers of Union soldiers who served only to defend the concept of the Union.

And this was an era when long travel was rare, so your strongest allegiance might well be to your state rather than that concept of Union.

Many, many men who were not slave-holders only fought to defend their southern home turf. That motivation was potent in the South.

When Robert E. Lee resigned from the Army at the onset of the war, he said he would never again draw his sword save in defense of his native state.

Yes, during the war, the Confederate battle flag was flown over brave and dedicated men. But in the 1960s, its aura was trampled to the ground by people seeking only to rebuff the civil rights of African Americans.

Rally round the flag! was a famous command in the 1860s. In the 1960s, those who rallied were too often expressing their hatred.

So where are we? Here and now, to many, many Virginians, the Confederate flag symbolizes a cruel and hateful past.

In a setting like a battle reenactment, a museum or an exhibit, the battle flag has its historical place. Beyond that, it becomes a symbol of harsh oppression and its flaunting becomes a lingering slap in the face.

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Where I stand on the Confederate flag controversy – Virginian-Pilot

Turkey’s president: ‘Nazism is alive in the West’ – USA TODAY

People protest outside the Dutch consulate in Istanbul after the Netherlands barred Turkish ministers from visiting. Video provided by AFP Newslook

A man gestures in front of a flag bearing a portrait of Turkish President Recep Tayyip Erdogan as Turkish residents of the Netherlands gather for a protest outside Turkey’s consulate in Rotterdam on March 11, 2017. Protests erupted in the Dutch port city of Rotterdam late on March 11 outside the Turkish consulate amid a row with Ankara after Dutch authorities banned the visits of Turkish ministers. About 1,000 people waving Turkish flags gathered on the street leading to the consulate, as tensions rocketed over rallies abroad to help Ankara gain backing for an April referendum vote.(Photo: Emmanuel Dunand, AFP/Getty Images)

Europe has been stripped of its maskand its real face is one of “fascism, racism and Islamophobia,” Turkish President Recep Tayyip Erdogan said Sunday.

Erdogan has been angered by recent bans on rallies planned by Turkish ministers in Germany and the Netherlands. The ministers were scheduled to speak with Turkish expatsahead of a crucial April 16 referendum on constitutional changesin Turkey that would strengthen Erdogan’s grip on power.

“The West has thrown off its mask in the past days,” Erdogan said Sunday. “What we have seenis a clear manifestations of Islamophobia.I have said that I had thought Nazism was over, but that I was wrong. Nazism is alive in the West.”

On Saturday, the Dutch government canceled Turkish Foreign Minister Mevlut Cavusoglu’sflight permit to the Netherlands, then refused to allowa convoy carrying Turkish Family MinisterFatma Betul Sayan Kaya toenter the Turkish consulate in Rotterdam, instead ushering her to the German border.

“Democracy, fundamental rights, human rights and freedoms… All forgotten in Rotterdam tonight. Merely tyranny and oppression.” she tweeted.

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Last week, Turkish ministers were barred from holding public rallies in two German cities.Erdogan accused Germany of “Nazi practices,” an accusation that drew a sharp rebuke from GermanChancellor Angela Merkel.

Local French officials in Metz agreed to allow a rally there, saying it did not pose a threat to public safety. That drew a nod from Erdogan, who thankedFrance for not “getting involved in such games.”

Dutch leaders say the Turkish rallies could increase tensions days before Dutch elections Wednesday that have drawn international attention. Populist Geert Wilders and his far-right Freedom Party, which has pledged to end Muslim immigration, close the nation’s mosques and ban the Koran,haveshown polling strength.

Hundreds of thousands of Dutch citizens have Turkish roots and could have voting rights in both nations. Dutch Prime Minister Mark Rutte said Sunday that he would attempt to repair relations with Erdogan and Turkey.Erdogan said Turkey would watch the election results and decide on its future relationship with the Netherlands.

“If you are sacrificing Turkish-Dutch relations for an election, you will pay the price,” Erdogan warned. Hesaid countries that ban his ministersagainst Turkey would soon “learn what international diplomacy is.”

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Turkey’s president: ‘Nazism is alive in the West’ – USA TODAY

Hidden war on drugs – Sentinel & Enterprise

Lancaster Police Lt. Everett Moody on Thursday shows off the hidden compartment police found in a vehicle after an recent arrest. The compartment was in the center console. SENTINEL & ENTERPRISE PHOTOS/JOHN LOVE

LANCASTER — On the surface, it looked like any other Pontiac G6. Inside the car, CD cases and articles of clothing were strewn about, animal hair from an unknown pet clung to the carpet, a child’s doll sat forgotten on the back seat.

But there was something else among the clutter that immediately caught Lancaster police Sgt. Patrick Mortimer’s attention.

The black sticky glue leaking from the car’s center console was the first clue.

“I saw that, and I knew right away that it wasn’t from something factory installed,” said Mortimer. “The other officer I was with thought I was crazy, but I kept telling him that I knew there was something in there.”

After finding a motor hidden deep within the car’s dashboard, the officers were able to activate an aftermarket option. Turning on that hidden motor caused the lower half of center console to suddenly swing out from beneath the radio, revealing a hidden compartment containing $7,000 in cash.

What began as a fairly routine vehicle stop and felony warrant arrest became the Lancaster Police Department’s first encounter with an electronically controlled secret compartment in a suspect’s car.

As the opioid epidemic has carried on, the technology drug sellers and smugglers have used to make their living has continued to evolve. As a result, departments throughout the state are getting their officers trained to spot the hidden compartments or “drug hides” that are continuously found in the vehicles of suspects.

“This was very professionally done.

Just two days before officers in Lancaster made their discovery, police in Nashua, found a similar electronic compartment inside the car of a Lawrence man who was hiding roughly 130 grams of cocaine.

A closeup of the console area. SENTINEL & ENTERPRISE PHOTOS/JOHN LOVE

And 10 days earlier, police in Ipswich arrested a Boston man after finding large quantities of cocaine and fentanyl in the hidden compartments of his car.

“It almost seems like the more law enforcement learns, the more the criminals learn,” said James Bazzinotti, whose company PACE New England offers the training course used by officers in Lancaster. “Everything the officers are learning now, the criminal element learned a few years ago. … We’re always a little bit behind.”

Over the course of the training, Bazzinotti said officers learn all the clues to finding drug hides that range from the low-tech oil cans with false bottoms to the professionally installed electronic systems that cost more than the cars they’re installed in.

Though extra spaces, or voids, can be found inside of any vehicle, and are frequently used by lower-level drug sellers, more complex ways of hiding illicit substances continue to be developed.

In many cases, compartments aren’t opened by simply flipping a switch but by initiating a sequence of settings within the car, Bazzinotti explained. A single button on a dashboard might open a secret compartment, but the car might have to be in neutral, the heat might have to be dialed to a specific setting, and a single seat belt might have to be buckled in before that button can actually work.

“It’s usually an owner-operator type of mechanic who does this kind of work,” Bazzinotti said. “They might work on cars but supplement their income by doing this.”

There’s no law in Massachusetts against having a hidden compartment in your car, and no law against installing them either. However, mechanics can be arrested on a conspiracy charge if it can be proven that they knew what the hidden compartment was going to be used for, Bazzinotti said.

States like Ohio, California, Georgia, Illinois and Oregon have adopted prohibitions on vehicle compartments and attempts to pass similar legislation have been made in Massachusetts as well.

In 2008, a bill was submitted to the state Legislature that would have made it illegal to own or install a hidden compartment in a vehicle, though it never made it to the House floor.

Fitchburg Mayor Stephen DiNatale, who had sponsored the petition while serving as a state representative of the 3rd Worcester District, said he was inspired to file the bill after hearing about the prevalence of hidden compartments from local law enforcement officials.

“From what they showed me, it was pretty elaborate devices and modifications that were being made to these vehicles,” DiNatale said. “These detectives have to go through a great deal of effort and work to find these things and yet there’s no requisite penalty for having them.”

He also explained that the bill had failed to gain any traction among other legislators largely because some felt its inclusion of vehicles such as aircrafts or boats was too broad.

“They didn’t want the legislation to be so far-reaching that it would affect law-abiding citizens,” DiNatale said.

The bill was refiled by current Fitchburg state Rep. Stephan Hay in January.

There is no way of measuring how many of these secret compartments are actually found and how many go unnoticed, but Mortimer estimates that a large majority of them go undetected.

However, the officers in Lancaster are undeterred.

“When you find one of these things it gets really exciting because it’s not every day that you find one of these,” he said. “Now everybody in the department wants to get trained.”

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Hidden war on drugs – Sentinel & Enterprise

Gamblers ‘lost more than 10000’ on fixed-odds betting terminals – The Guardian

GambleAware said one person had lost 13,777.90 in a marathon seven-and-a-half-hour session on an FOBT. Photograph: Alamy Stock Photo

Seven gamblers lost more than 10,000 in a day while using controversial fixed-odds betting terminals (FOBTs) during a 10-month period, it has emerged.

The losses, revealed in a submission to the governments gambling review by the GambleAware charity, has sparked renewed criticism of FOBTs.

The charity analysed data from betting sessions, including cases where punters bet the maximum allowable amount of 100, which can be staked every 20 seconds under existing regulations.

It found that in 5.4m sessions over 10 months, 3% of the total included at least one bet of 100, while those who staked the maximum typically did so more than once per session.

It also reported several extreme outliers, cases where gamblers lost huge amounts of money in a single session.

Seven sessions saw customers lose more than 10,000 within a few hours, with one gambler losing 13,777.90 more than half the UKs national average wage in a marathon seven-and-a-half-hour sitting.

Staff in bookmakers high street shops, which took 1.7bn in revenues from FOBTs last year, are meant to intervene if they are concerned about a customers losses or the source of their funds.

Social responsibility requirements mean all operators must interact with customers where they believe they could be at risk of problem gambling, but also where any transactions could be linked to crime, said the industry regulator, the Gambling Commission, which has signalled a tougher stance against firms that fail to prevent problem gambling.

Carolyn Harris MP, who chairs a cross-party group that has recommended slashing the maximum stake on FOBTs to 2, said examples of such large losses, though rare, were concerning.

Those are obscene losses, she said.

For me, if anybody can sit there for that long and lose that much money, theyre not being watched and there is no intervention.

She also questioned whether firms were implementing anti-money-laundering controls properly in the light of recent examples of criminals using FOBTs to launder the proceeds of crime.

She said it was unfair to put shop staff in the position of having to stop someone from betting when they were losing a lot of money.

Why should cashiers be forced to intervene? Its above their pay grade.

There has to be a better way, such as having specialist individuals to deal with problem gambling.

GambleAware said there was not sufficient evidence to suggest that problem gambling was being caused by FOBTs.

But it said it was irrefutable that gaming machines are associated with harms.

The charity also found that problem gamblers and the unemployed were more likely to place a 100 bet than other players, as were loyalty card holders.

It said the proportion of sessions including a 100 bet also doubled after 10pm, rising from 3% of sessions to 6%.

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Gamblers ‘lost more than 10000’ on fixed-odds betting terminals – The Guardian

Enjoy Cheltenham but the gambling fun never stops for the bookies – The Guardian (blog)

Discarded betting slips at the Cheltenham Festival, which last year drew a record total crowd attendance of 260,579. Photograph: Tom Jenkins for the Guardian

They say there is more Guinness spilt annually at the Cheltenham Festival than champagne quaffed at Royal Ascot. Its a hoary old saw that probably isnt true, but helps add to the sense of chaotic ribaldry with which National Hunt racings annual March jamboree is associated compared to its supposedly more genteel and moneyed Flat equivalent. In the coming days scenes of bawdy triumph and utter despair will unfold in what us hacks are obliged to refer to at least once per year as the great natural amphitheatre of Prestbury Park, where racing enthusiasts from both sides of the Irish Sea will convene for drinking, gambling and high quality sport that is unrivalled in its sheer intensity for those of us who are into those kind of things.

While the Cheltenham Festival is a carnival of top-class racing, it is difficult to get away from the notion that without the attendant vices it would just be predominantly Irish men riding horses around an otherwise very sparsely attended field: a noble but ultimately futile pursuit that becomes a whole lot more fun with the introduction of hundreds of thousands of excitable, liquored-up punters clutching betting slips and roaring their fancies home. When the fun stops, stop, the bookies are obliged to tell us in their promotional material these days although one gets the feeling that were your fun to stop three races in when youve just done your nuts on Tuesdays Festival Handicap Chase, these less-than-rigorous enforcers of what does and does not constitute fun would not be at all adverse to you handing over even more money, money you might not necessarily be able to afford in an effort to recapture that warm and fuzzy glow of carefree optimism in which you found yourself enveloped before the tapes went up for the first race.

While it is all well and good to encourage people to stop gambling when it has become a source of teeth-grinding, potentially life-ruining misery and anguish, the simple fact of the matter is that even when the fun stops, there are plenty of punters out there who just cant resist throwing good money after bad, loading themselves with so much debt that their own lives and the lives of those around them are utterly destroyed by a craven inability to stop betting. Weve all seen the pictures of the former England full-back Kenny Sansom, homeless and passed out in a park or shuffling to and from the bookies that accompany tabloid stories detailing his desperate pleas for help on the grounds that he feels utterly incapable of helping himself. Its probably safe to say the fun stopped for Kenny a long time ago, but still he continues to fill out those betting slips.

The fun almost certainly came to an abrupt halt for Cathal McCarron when he was encouraged by the IRA to leave Northern Ireland for London after gambling so much money he could not afford that he took to stealing from friends and neighbours. A top-level Gaelic football player with County Tyrone in Ireland, McCarron continued with his punting to such an extent that he found himself agreeing to star in a gay porn movie, for which he was paid 3,000 and assured that his debut screen performance would be shown only on pay-per-view channels in a chain of American hotels.

Appalled by what he had done, but with the consolation of a few quid in his pocket to help him try to get his life back on track, McCarron treated himself to a chocolate bar and proceeded to blow every remaining penny of his appearance fee in the betting shop within two days. A short time later, when news of his cinematic escapades had inevitably made headlines in the papers back home, McCarrons life was saved when he received a supportive call from a family member as he tried to work up the courage to throw himself under a London tube train. He has since faced, if not completely conquered his demons and revealed the pitiful depths of self-loathing to which he was reduced by his gambling habit in a harrowing autobiography.

Ultimately it is the problem gambler, not the bookmaker, who is responsible for dealing with their addiction once what bookies label the fun has stopped and it would be churlish to suggest otherwise. However, for all their commitment to tail-ending their increasingly intrusive adverts with a catchy and largely meaningless platitude, the sheer volume of relentless promotion with which the giants of the bookmaking industry assail sports fans on a daily basis suggests that, for all their talk, they are not hugely interested in discouraging anyone from making a regular donation.

During a splendid week of sport in which highlights include an FA Cup tie between Chelsea and Manchester United, several Champions League matches, four days of thrilling racing and the denouement of the Six Nations, sports fans will find themselves driven to distraction by bookies falling over themselves to win the custom of regulars and the all important potential new customers with various adverts, promotions and the usual tediously unfunny stunts that may involve an overweight footballer and a pie. Across the bookmaking industry more than 350m is expected to be wagered on Cheltenham alone and we all know where most of that will end up. The fun never seems to stop for the bookies.

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Enjoy Cheltenham but the gambling fun never stops for the bookies – The Guardian (blog)